Dental lasing device system and method

ABSTRACT

A diode laser system having high-power diode(s) said high-power diode(s) producing laser outputs in a range of 0.1 to 25 Watts of power using optimum wavelengths via a single optical delivery fiber.

PRIORITY CLAIM AND INCORPORATION BY REFERENCE

This application is a continuation of U.S. patent application Ser. No.16/279,892 filed Feb. 19, 2019 and entitled Dental Lasing Device Systemand Method which claims the benefit of U.S. Prov. Pat. App. No.62/631,949 filed Feb. 19, 2018 and entitled Dental Lasing Device Systemand Method.

This application incorporates by reference, in their entireties and forall purposes, U.S. Pat. No. 9,597,160 entitled LASER-ASSISTEDPERIODONTICS and U.S. Pat. No. 5,642,997 entitled LASER EXCISIONAL NEWATTACHMENT PROCEDURE.

BACKGROUND OF THE INVENTION Field of Invention

This invention relates to the field of manufactured electrical andmanufactured electromechanical devices. More particularly, the presentinvention relates to medical lasers and to medical lasers using laserdiodes.

Discussion of the Related Art

Medical lasers including diode lasers are medical devices such as thosedefined in 21 U.S.C. 321(h). These devices are manufactured, designed,intended or promoted for in vivo laser irradiation of the human body forpurposes including diagnosis, surgery, reconstructive surgery, ortherapy.

In dentistry, diode lasers operating at a wavelength of 810 or 980nanometers (nm) are known while other available wavelengths between 800and 1064 nm have been used less frequently. Notably, even after U.S. FDAclearance more than 20 years ago, many dentists have little knowledge oflasers.

SUMMARY

The invention described herein relates generally to laser assemblies andto laser assemblies including laser diodes.

FIG. 1 and FIG. 2A-D show a laser assembly 10 and some of the componentsthat may be included therein. In various embodiments, a laser diodemodule 20 is mounted within a housing 22. The housing may also enclose alaser power meter 70, and an electrical circuit board(s) 80 includingmounted components such as a microprocessor 50, A/D converter(s) 11, andcomplementary circuit elements 13. Laser emission power outlets 15, atransducer to transmit audible alerts, and controls 17 may be providedalong with delivery systems including one or more of a single opticalfiber for delivery 25, a handle 23, and/or a tip 21. Laser emissionoutputs of up to several Watts and multiple (e.g., three) wavelengthsmay be provided from a single laser delivery fiber.

The laser assembly or device 10 may produce laser outputs of up toseveral Watts. This power is provided to the treatment area by a singlelaser delivery fiber while the laser(s) are operated at multiplewavelengths, three wavelengths, two wavelengths, or one wavelength. Forvarious procedures one laser may be operated, two lasers may be operatedsimultaneously, or three lasers may be operated simultaneously.

For example, the laser assembly 10 may be specifically suited to dentalapplications such as heating, curing, tacking, photopolymerization ofcomposite, cutting soft tissue, disinfecting periodontal pockets,hemostatic assistance, adjunctive use in caries detection, tissueretraction for impressions, gingival incisions and excisions, treatmentof aphthous ulcers and herpes type 1 lesions.

Some embodiments of the laser device 10 decrease composite curing time,increase photopolymerization rates of the composite, and/or provide forbeneficial use of multiple wavelengths (e.g., 1064 nm, 450 nm, 635 nm)including convenient access to multiple polymerizing wavelengths thatavoid the need to change from one laser device to another. Notably,wavelengths may be associated with particular characteristics such as1064/infrared or non-visible, 450 nm/blue, 635 nm/red.

In some embodiments, the laser device aids the clinician in (a)pinpointing, polymerizing a small area of composite while leaving therest of the composite flexible for routing around the patient's teeth,and (b) polymerizing composite from the opposite side of the tooth(through the tooth) from the delivery fiber. Broader areas may bepolymerized in a conventional manner. This work may take place withoutthe need to adjust controls on the user interface. For example, a lowerintensity results from increasing the distance between the outputsurface of the optical fiber and the surface of the composite materialwhich increases the surface area painted by the polymerizing light. Thisis due to the conical spreading of the light beam which is proportionalto the distance of the fiber to composite surface and the angle θ,theta, the value of which is determined by the numerical aperture of theoptical fiber (NA=n sin θ, where NA is the numerical aperture, n is theindex of refraction of the optical fiber, and θ is the limiting angle ofthe conically spreading light beam).

In an embodiment, a laser device 10 has a high-power diode laser module20. The module may produce laser emissions of several Watts power (e.g.,1-6 and up to 25 Watts) via a single optical fiber. The laser emissionsoutputs 15 may be produced at various visible light wavelengths and atwavelengths above and below those of visible light. For example,wavelengths may include 1064±10 nm, 450±10 nm, and 635±15 nm and thelaser emission may be continuous or pulsed.

FIG. 3A-D show laser operating modes 300A-D. When the laser device 10 isprogrammed for multiple wavelength output or when multiple wavelengthsare requested by the operator, laser operation results in amulti-wavelength emission. Emission of these wavelengths may be (a) as acontinuous wave (see FIG. 3A), (b) as a series or sequence of individualwaves of similar or different wavelengths (see FIG. 3B), (c) assimultaneous emissions of similar or different wavelengths (see FIG.3C), or (d) as a combination of these such as an emission of a singlewavelength followed by an emission of multiple wavelengths followed byan emission of a single wavelength (see FIG. 3D). Any combination of theabove emissions may be used. Emissions as in (b) or (d) can occur eitherin immediate succession or with an overlap such that there are periodsof simultaneous emission of two or three wavelengths and at other timesthere are periods of a single wavelength emission.

The energy emitted from the laser diode module 20 can be pulsed orcontinuous wave output. For example, the above emissions 3A-D may bepulsed or not and pulse duty cycles may be varied, for example, tocontrol energy delivered. Pulse duty cycles may range from 0.3% to 99%with 100% being continuous operation.

As indicated above, the combinations of multiple, such as two or three,wavelengths may be emitted simultaneously, consecutively, sequentially,or in any order. Sequential emissions may be directed in an overlappingmanner, for example where there are intervals during the duty cycle withas many as three simultaneous wavelengths emitted and other intervalswhere only a single wavelength is emitted. Sequentially means thebeginning of a first event falls after the beginning of a second event.Consecutive means following immediately thereafter.

FIG. 4 shows an optical fiber 400. The power of the emissions may beindependently measured by an included power meter 70. For example, thepower meter may be mounted/configured, for example in a diode lasingdevice housing, to measure laser power output using a feedback loop forensuring that actual laser energy delivered corresponds to a selectedset point. Notably, the power meter may measure power at various stagesof the output, for example at the laser diode module 20, optical bench533, delivery fiber input 451, or delivery fiber output/probe output463.

With regard to optical fiber construction, the fiber may have a corediameter 457, for example a 360 μm diameter, and it is from such adiameter that light is emitted, said diameter excluding any coatings orshields that may be required for the proper use or operation of thefiber. In general, core diameters may range between 100 and 1,000 μm andmay have numerical apertures (N.A.) within a range of 0.12 to 0.53 witha preferred embodiment range of 0.22 to 0.34.

As discussed, light may be emitted at various wavelengths and emittedusing continuous, consecutive, sequential, overlapping sequential,simultaneous, and/or mixed laser operation including pulsed laseroperation. This light reaches a delivery fiber 25. The output (distal)end of the fiber may be contained and directed by a hand tool or thelight may thereafter reach a hand tool or probe 23 with or without a tip21 for use on a patient. The delivery chain and its individualcomponents may be optimized to heat and/or polymerize dental compositeswhether they be inside or outside a tooth. For example, composites maybe exposed and thus able to be heated directly. For example, compositesmay be contained within a tooth or container in which case they may beheated indirectly via a tooth or container wall or sidewall, or thecomposite may be located on the side of the tooth away from where theoutput of the delivery fiber may be conveniently presented, and thecomposite may be heated and cured through the tooth.

The energy is emitted in various patterns, e.g., in a consecutive orsequential pattern (e.g. Near-Infrared followed by Blue) or in asimultaneous pattern (e.g., Near-Infrared and Blue together) or in anoverlapping pattern (e.g., Near-Infrared, Near-Infrared and Blue, Blue)so as to heat and polymerize the dental composite.

Other user interface selections adapt the laser device for performingother applications. For example, light energy emitted in the variouswavelengths and output in the various patterns/combinations may beconducted by the delivery fiber 25 and used/optimized for hemostaticassistance, adjunctive use in caries detection, tissue retraction forimpressions, gingival incisions and excisions, aphthous ulcer treatment,and treatment of herpes type 1 lesions.

Light emissions used for these other applications may be emitted invarious patterns. For example, light emissions may include: sequentialemissions (e.g., Near-Infrared followed by Blue) or simultaneousemissions (e.g., Near-Infrared and Blue together) or overlappingemissions (e.g., Near-Infrared, Near-Infrared and Blue, Blue) in aneffort to assist the operator in performing these procedures.

In an embodiment, a diode lasing device for dentistry and oral surgerycomprises: a laser diode module in a lasing device housing; the lasermodule including three or more laser diodes; a first laser diode (blue)for emitting light with a wavelength of 400 to 510 nanometers at a powerof 0.1 to 5 Watts; a second laser diode (infrared) for emitting lightwith a wavelength of 800 to 1200 nanometers at a power of 0.1 to 25Watts; a third laser diode (red) for emitting light with a wavelength of600 to 750 nm at a power of 1 to 1,000 milliWatts; light from the first,second, and third laser diodes received by an optical element forcombining multiple laser beams into a single beam; and, a single opticalfiber with a core diameter of 100 to 1,000 μm for receiving the singlebeam and transporting the single beam for use in patient treatment.

The diode lasing device may comprise: an operating mode that varieslaser power by pulsing the laser at a frequency of 10 Hz to 50 Hz using20 to 100 msec pulse width and a 50% duty cycle. The diode lasing devicemay comprise: another continuous wave operating mode. The diode lasingdevice may comprise: a first laser operating mode that varies laserpower by pulsing the laser at a frequency of 10 Hz to 50 Hz using 20 to100 msec pulse width and a 50% duty cycle. The diode lasing device maycomprise: a second laser operating in continuous wave mode. The diodelasing device may comprise: in the first laser operating mode, the laserduty cycle is 20% to 65%. The diode lasing device may comprise: anoutput power of the single beam is independently measured and controlledto a particular set point via a feedback loop with a power meter. Thediode lasing device may comprise: a facility that sums and displays theaccumulated energy output, or light dose delivered, in Joules, beginningat zero and summing during all laser emission periods where the countermay be reset to zero upon operator command. The diode lasing device maycomprise: within the diode lasing device housing, a laser power meterthat measures actual power (Watts) to confirm the power of the singlebeam emitted from the fiber equals the displayed power setting. Thediode lasing device may comprise: a facility giving timed warnings toprevent a) over-polymerization of a composite or b) over-energizing atissue. The diode lasing device may comprise: a first laser for emittinglight with a wavelength of 400 to 510 nanometers at a power of 0.1 to 5Watts; and, a laser variable power operating mode that uses pulses at afrequency of 10 Hz to 50 kHz using a 20 to 100 msec pulse.

The diode lasing device may comprise: for in vivo dental compositeheating and subsequent photopolymerization, a near-infrared laseroperated at 0.4 to 2.0 Watts for 5 to 30 seconds is used to heat thecomposite for, the laser emitting light with a wavelength of 800 to 1200nanometers; and, after heating the composite, automatically deactivatingthe near-infrared laser and automatically activating the blue laser at0.2 to 0.4 Watts for 1 to 10 seconds using a 10 to 30 Hz pulsed emissionfor photopolymerizing the composite. The diode lasing device maycomprise: for gingival incisions and excisions, the first laser isactivated to deliver 0.4 to 1.0 Watts at the distal end of the singleoptical fiber which is placed proximate the soft tissue to be incised orexcised; and, a second laser with a wavelength of 800 to 1200 nanometersfor soft tissue incisions and excisions is activated to deliver 0.4 to1.6 Watts at the distal end of the single optical fiber which is placedin contact with the soft tissue to be incised or excised. The diodelasing system may comprise: for tissue retraction for impression, thefirst laser delivers 0.4 to 1.0 Watt at distal end of the single opticalfiber which is placed in contact with the inner epithelial lining of thefree gingival margin, and the tip being angled toward the soft tissue;and, a second laser with a wavelength of 800 to 1200 nanometers for softtissue retraction delivers 0.4 to 1.0 Watt, the distal end of the singleoptical fiber placed in contact with the soft tissue to be retracted.The diode lasing system may comprise: for hemostatic assistance, thefirst laser delivers 0.5 to 1.0 Watt to control bleeding, the distal endof the single fiber 1 to 4 mm away from wounded soft tissue; and, forhemostatic assistance, a second laser with a wavelength of 800 to 1200nanometers, the second laser delivers 1.0 to 2.0 Watts to controlbleeding, the distal end of the single fiber placed in contact with thetarget tissue. The diode lasing system may comprise: for aphthous ulcertreatment, the first laser delivers 0.4 to 0.6 during a 10 to 30 Hzpulsed emission, the distal end of the single fiber held angledperpendicular to a lesion at a designated distance from the surface; thefiber is moved in a circular motion over the entire lesion and slightlybeyond the borders of the ulcer, the circular motions lasting 20 to 40seconds and repeated 3 to 5 times with 10 to 15 second intervalstherebetween; and, a second laser with a wavelength of 800 to 1200nanometers is for aphthous ulcer treatment, the second laser delivering0.6 to 1.0 Watt continuous or pulsed emission at 10 to 30 Hz from thedistal end of the single fiber which is placed and angled perpendicularto the lesion.

The diode lasing system may comprise: for adjunctive use in cariesdetection, a blue laser with a 0.1 to 0.3 Watt emission at the distalend of the single fiber is placed in contact with a tooth surface;illumination on the opposite tooth surface is observed; the above stepsare repeated to cover substantially the whole surface of the tooth andto examine the entire clinical crown; under laser illumination a) areasof decalcification, superficial stain, and decay that appear darker thanhealthy enamel are observed, b) the presence of a characteristicluminescence indicative of carious dentin is observed; c) the removal ofdecay during cavity preparation is observed; and d) through conventionalmeans, the presence of decay is observed.

In some embodiments an appliance for dental and oral surgery uses one ormore diode lasers comprising: a laser system with means for outputting asingle beam from a laser; the beam having two or more selectedwavelengths of light; and, the beam having a pulsed duty cycle. In someembodiments an appliance for dental and oral surgery comprises: laserdiode integrated circuits for each wavelength mounted within a modulehaving laser outputs focused by a set of optical elements such that acombined emission is transported by a single optical fiber. In someembodiments an appliance for dental and oral surgery uses one or morediode lasers comprising: the use of selected wavelengths of light, eachone of blue with a wavelength of 400 to 510 nm, infrared with awavelength of 1054 to 1074 and red visible. In some embodiments anappliance for dental and oral surgery uses one or more diode laserscomprises: means for delivering laser power of up to 5 Watts (W) at 450nm and 10 W at 1064 nm, and up to 1,000 mW at 650 nm.

In some embodiments an appliance for dental and oral surgery uses one ormore diode lasers wherein light at each of the wavelengths is emitted ata duty cycle between 20 and 65%. In some embodiments an appliance fordental and oral surgery uses one or more diode lasers wherein thewavelengths are emitted simultaneously. In some embodiments an appliancefor dental and oral surgery uses one or more diode lasers wherein thewavelengths are emitted consecutively. In some embodiments an appliancefor dental and oral surgery uses one or more diode lasers whereinemissions start at different times but overlap.

Embodiments also include a laser system wherein the emissions alternatewith no gap in time therebetween. Embodiments also include a lasersystem wherein: the beam is delivered by a single fiber with a corediameter within a range of from 100 to 1,000 μm. Embodiments alsoinclude a laser system wherein the single optical fiber has a numericalaperture within a range of from 0.12 to 0.32. Embodiments also include alaser system wherein the single optical fiber has a numerical aperturewithin a range of from 0.18 to 0.28. Embodiments also include a lasersystem wherein emissions of blue light and infrared light are optimizedto heat and photopolymerize in situ dental composite.

Embodiments also include a laser system wherein photopolymerization ofdental composites is carried out by positioning a distal end of thelaser optical fiber perpendicular to the resin-based composite (RBC)within 2 to 6 mm of the RBC on/within tooth. Embodiments also include alaser system wherein light is delivered in 3-5, 1-6, 4-8, 8-20 secondduration cure cycles, with user-commanded timing intervals. Embodimentsalso include a laser system wherein the optical fiber has cladding andan inside diameter of the cladding is about 360 microns. Embodimentsalso include a laser system wherein: a Peltier cell is operated as athermoelectric cooler for cooling the laser module; and, the Peltiercell is between the packaged laser diode module and a heat sink fordissipating the heat lost from the laser module. Embodiments alsoinclude a laser system wherein: a motorized cooling fan cools the heatsink; and, the cooling fan is mounted opposite the Peltier cell with theheat sink therebetween.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention is described with reference to the accompanyingfigures. These figures, incorporated herein and forming part of thespecification, illustrate embodiments of the invention and, togetherwith the description, further serve to explain its principles enabling aperson skilled in the relevant art to make and use the invention.

FIG. 1 shows a block diagram of the laser device of the presentinvention.

FIG. 2A shows a front elevation view of the laser device of FIG. 1.

FIG. 2B shows a right side elevation view of the laser device of FIG. 1.

FIG. 2C shows a side elevation view of the laser device of FIG. 1.

FIG. 2D shows a top plan view of the laser device of FIG. 1.

FIG. 3A-D shows operating modes of the laser device of FIG. 1

FIG. 4 shows an optical fiber for use with the laser device of FIG. 1.

FIG. 5 shows a side view of a cooling system for use with the laserdevice of FIG. 1.

DETAILED DESCRIPTION

This disclosure provides examples of some embodiments of the invention.The designs, figures, and description are non-limiting examples ofcertain embodiments of the invention. For example, other embodiments ofthe disclosed device may or may not include the features describedherein. Moreover, disclosed advantages and benefits may apply to onlycertain embodiments of the invention and should not be used to limit thedisclosed invention.

To the extent parts, components and functions of the described inventiontransport light, transport signals, or exchange fluids, the associatedinterconnections and couplings may be direct or indirect unlessexplicitly described as being limited to one or the other. Notably,indirectly connected parts, components, and functions may be coupledalthough they have interposed devices and/or functions.

Described herein are embodiments of a dental laser device and methods ofperforming particular dental procedures using a diode laser device orsystem. Notably, safe and appropriate use of lasers requires a clinicianwhose training includes knowledge of laser delivery systems andlaser-tissue interactions.

Diode lasers used in dentistry may provide a number of advantagesincluding a bloodless operating field, minimal swelling and scarring,and less or no post-surgical pain. The light produced by these lasersincludes wavelengths that may be visible to the human eye andwavelengths that may be above (infrared) or below (ultraviolet) therange of visibility to the human eye.

Lasers emit a coherent wavelength of electromagnetic radiation that maybe used to: heat and/or cure dental materials including composites; andcut, coagulate, ablate, or treat tissue in various clinicalapplications. As mentioned above, laser systems can produce light atdifferent wavelengths and may vary laser power/laser energy levelsusing, for example, pulses and variable pulse durations.

The coherent light is emitted in various wavelengths and the output mayinclude various combinations of emitted wavelengths. Where laser outputis delivered, for example, via optical fiber 25, it may be used to: (a)heat and/or cure and/or polymerize dental composite; (b) heat and thenpolymerize dental composite; (c) perform hemostatic assistance; (d)retract tissue for impressions, perform gingival incisions andexcisions, treat aphthous ulcers and herpes type 1 lesions; (e) provideadjunctive use in caries detection; and (f) perform photocoagulation orvaporization of soft or fibrous tissue, curing of light-activated dentalmaterials, adjunctive use for endodontic orifice location, andlight-activation of bleaching materials for teeth whitening.

In various embodiments the laser device 10 of the present invention mayinclude a logic section 133, a first accessories section 131, and asecond accessories section 135. The first accessories section includesone or more of a power supply 30, a power switch 103, a key switch 105,an interlock 107, a foot switch 90, SMA device(s), a transducer fortransmitting audible alerts, and a housing 22. SMA devices may includeSMA connector(s) and/or SMA detector(s) 109, the detectors for detectingproper optical and/or mechanical interface(s).

The logic section includes one or more of a user interface 24, buttons26, screen 28, internal reference 41, circuit board(s) 80,microprocessor 50, memory 51, A/D converter(s) 11, complementary circuitelement 13, laser diode module 20, laser diodes 21, a power meter 70,and an auto calibration loop 71.

The second accessories section includes one or more of a wavelengthcombiner or optical table 533, Peltier cooler 557, fan 60, temperaturesensor(s) 56, heat sink 59, laser emission power output 15, and controls17. Details concerning a number of these components are provided below.

Laser Diode Module

The laser diode module 20 includes laser diode semiconductor device(s)and circuitry that supports the laser diodes. In various embodiments thedental lasing device includes a housing 22, one or more electricalcircuit boards 80, a microprocessor 50 mounted on one of the circuitboards, an optical table 533, and interconnecting conductors 104.

Each diode 21 of the laser diode module 20 is a coherent light sourcewhere coherent light refers to an emission of light at a singlefrequency and phase. For example, the light emission may be in thevisible, near-infrared (“IR”), or infrared spectrum. The coherent lightmay be provided at multiple wavelengths and at variable/high power 25.

Each of the wavelength-specific laser diode integrated circuits (“ICs”)is mounted within the laser diode module 20. The laser outputs of theICs are directed to an optical table 533 that includes a set of opticalelements 54 focusing light at various wavelengths into a single opticalfiber 25. Electrical current passing through the semiconductor 21 PN orNP junction stimulates and regulates the energy production of a coherentlight emission. In a similar manner, when the electrical current stopsso too the emission stops.

In an embodiment, the laser diode module 20 includes three diodesub-modules 21. Each sub-assembly produces an emission at a particularwavelength or wavelength band. Exemplary wavelengths or wavelength bandsinclude 1064±10 nanometers (nm) wavelength, 450±10 nm wavelength, and635±15 nm wavelength.

Diode capacity may be selected to provide various power outputs. Forexample, the maximum power of the 450 nm emission band may be 5 Watts(W), the maximum power of the 1064 nm emission band may be 25 W, and themaximum power of the 635 nm band may be 1,000 mW (milliWatts).

As shown above, in some embodiments the laser diode module 20 includeslaser diodes 21 whose center wavelength varies from values of 450, 635and 1064 nm. For example, the 450 nm laser diode may bereplaced/augmented with a laser diode having a center wavelength 450nm±4.5 to 45 nm (e.g., 1% to 10%). In a similar manner the 635 and 1064nm diodes may be replaced/augmented.

And, in some embodiments, light from diodes 21 that provide a broaderspectrum is filtered by opto-mechanical assemblies included in the lighttable. Notably, various ones of these broad spectrum diodes may requireadditional cooling using Peltier cell cooling 57, water cooling, oranother suitable cooling means known to persons of ordinary skill in theart.

Optical Table

In various embodiments, the laser diode module 20 may combine laseremissions of various wavelengths. The module may include plural opticalfibers attached to plural diodes 21. Diode or fiber optical outputs maybe combined via one or more opto-mechanical devices 533 such that asingle output for use with a single optical fiber results.

In another embodiment beams are combined. Here, multiple distinct beamsfrom multiple lasers impinge on a transformation lens 593 which focusesthe beams to a single point on a dispersion element 595. The dispersionelement emits a single beam that impinges on an external cavity mirror597. In combination, the external cavity mirror and dispersion elementmay define an external cavity. Notably, the dispersion element may turnthe emitted beam through an angle of 90 degrees relative to the beamsemitted by the lasers.

In an embodiment, laser diode ICs 21 for each wavelength are mountedinside the laser diode module 20. Within the module, the IC laseroutputs are focused by a set of light table optical elements 533. Theseelements receive light from multiple fibers having core diameters of 50to 1100 μm and they light a single optical fiber having a 100 to 1000 μmoptical core diameter.

Optical Fiber Delivery

An optical delivery fiber 25 is attached to the laser diode module 20.In various embodiments the attachment is via a single mechanical andoptical interface located at the optical table output 15.

As mentioned, the optical delivery fiber core 457 from which light isemitted has a diameter of between 100 and 1000 μm. The fiber has anumerical aperture (N.A.) within a range of about 0.12 to 0.53 and apreferred embodiment in the range of about 0.22 to 0.34. The core may besized to deliver laser power of up to 5 W at 450 nm, 25 W at 1064 nm,and up to 1,000 mW at 635 nm. The distal end of the optical deliveryfiber 25 may be attached to a hand-held probe 23 useful for directingthe fiber output.

System Cooling

Semiconductors and opto-mechanical devices have thermal losses. Forexample, not all of the electrical current passing through the laserdiodes is converted into coherent light emissions.

This efficiency loss includes junction resistance where the heatgenerated is proportional to the product of the semiconductor junctionresistance and the current to the second power (I{circumflex over( )}2*R). In similar fashion, where the emission is reflected andtransmitted within the opto-mechanical components 54 thermal lossesoccur.

Thermal losses tend to cause a temperature rise in the laser diodemodule 20. But, the module 20 must be maintained within a suitabletemperature range (e.g., 50 to 80 degrees Celsius) that avoids ICthermal damage or degraded performance.

A cooling system 502 solves this problem for the above-mentioned laserdiode module 20. The cooling system includes temperature sensor(s) 56, acooling module 557, heat sink(s) 559, and a fan 560. In variousembodiments, the cooling module is a Peltier cell type thermo-electriccooler.

The cooling system 502 is mounted near to or to the optical table 533and a cooling system bracket 555 may be used to fix the cooler. Thecooling system or its bracket includes temperature sensors 56 providingfeedback for controlling operation of the thermo-electric cooler 557.Heat transferred to the heat sinks from the thermo-electric coolers issubsequently removed from the heat sinks by circulating air provided bythe cooling fan 560 such as a muffin fan.

In some embodiments, the cooling system 502 cools the wavelengthcombiner or optical table 533 and/or the diode module 20. For example,the diode module may be within the optical table or it may be cooledseparate from the optical table.

In some embodiments, the lasing device of claim includes a Peltier celloperated as a thermoelectric cooler for cooling the laser module and thePeltier cell is located between the packaged laser diode module and aheat sink for dissipating the heat lost from the laser module. And insome embodiments a motorized cooling fan cools the heat sink and thecooling fan mounted opposite the Peltier cell with the heat sinktherebetween.

Current Control

In the laser diode module 20 electrical current passes through the laserdiodes in response to microprocessor controls. The electrical currenttransferred to the diodes 21 is in response to commands that includeanalog and/or digital signals. For example, digital commands from themicroprocessor may subsequently be converted to analog signals beforethey are used to control the laser diodes.

The energy emitted from the laser diode module can be varied. Forexample, the laser may be turned off and on repeatedly and/or rapidlysuch that the laser emission “pulses.” In this case, a pulse duty cyclecontrols the energy delivered by the laser. These pulses may providevarious wavelengths of light that are in time arranged in parallel orserially. In cases the pulses of light may overlap.

In another case, the laser device 10 is operated continuously such thatthe laser power output may be at levels indicated by the laser outputpower rating. Whatever the case, the laser power level is determined bya microprocessor command or instruction that sets the laser power level.

Laser diode module 20 including multiple laser diodes 21 have emissionsthat can include several wavelengths of light, for example the discretewavelengths emitted may be as numerous as the laser diodes. These diodesmay be operated to emit wavelengths one at a time or in some or anycombination.

For example, the combinations of two or three wavelengths may be emittedsimultaneously, in sequence, or in any order selected by the laseroperator. Sequential emissions may be directed in an overlapping mannerwhere, for example, there are intervals during the duty cycle when twoor more, or three, wavelengths are emitted simultaneously and otherintervals where only a single wavelength is emitted.

As discussed above, this emission of one or more wavelengths may becarried by a single fiber. In various embodiments this single fiber isconnected to the laser diode module or to the optical table output.

For pulsed lasers, the duty cycle may be from 0.3% to 99% with 100%being continuous duty. Where the lasers emit 5 W at 450 nm, 25 W at 1064nm, and 1000 mW at 635 nm, clinically effective duty cycles may vary inthe range from about 20% to about 65%.

Preferred Operating Specifications

Operating modes may include continuous wave (CW) operation, pulsedoperation, and pulsed operation at 25 Hz. Operating modes may alsoinclude serial pulsed mode where, for example, 20 seconds of operationat 1064 nm is followed by 5 seconds of operation at 450 nm andthereafter, simultaneous pulsed mode operation at 1064 nm and 450 nm.

Output power for the 1064 nm wavelength may be 0.5-25 Watts in CW mode(0.1 W increments) and 0.1 to 25 Watts average in pulsed mode. In serialpulsed mode up to 2 Watts average power may be used. In simultaneouspulsed mode, the power may be 0.1-2 Watts total average power which isthe sum of the power from the 1064 nm beam and the power from the 450 nmbeam where these beams are of equal power.

Output power for the 450 nm wavelength may be 0.1 to 5 Watt in CW modeand 0.1 to 2 Watts average power in pulsed mode. In serial pulsed modeup to 2 Watts average power may be used. In simultaneous pulsed mode0.1-2 Watts total average power (50%/50%) may be used.

Output power for the 635 nm wavelength may be 1000 mW maximum with anaimed beam. In pulsed mode the pulse width may vary from 10 nanosecondsto 500 milliseconds.

In some embodiments, input power of a three diode laser device is 30Watts. And in some embodiments, the related input voltage is 12 VoltsDC.

Internal Power Meter/Auto Calibration Loop

Factors such as optical fiber contamination, radiation fatigue, andimproper output fiber cleaning may affect or negatively affect laseroutput power. Power meter 70 enables measuring laser power output.

The power meter 70 is mounted for measuring laser power output. Forexample, power output may be measured at the laser diode module 20, atthe wavelength combiner or optical table output 15, or at the distal endof an optical fiber (delivery fiber) connected to the output 15. Thispower meter enables calibration of the laser power output such that at aparticular indicated laser power (e.g., laser power setting) the laserdelivers a specific or predetermined amount of power.

In an embodiment this is accomplished by using a laser device 10internal reference 41 to which the power meter 70 reading is compared.In various embodiments, auto calibration is provided using the powermeter and the internal reference. In some embodiments, where laseroutput is measured at the output 15, auto calibration takes into accountlosses that occur in the delivery fiber 25 and may take into accountlosses that occur in any optical fiber attachments 21. In such cases,this may provide more accurate estimates of energy delivered to thetreatment site.

In some embodiments, a calibration subsystem 71 is used for diode lasingdevice calibration. Here, diode lasing device displayed power setting isset to deliver a specific power that matches an internal power reference41. When the power meter 70 measures the actual laser power exiting thedelivery fiber 25, this measurement should match the reference powervalue. If it does not, the displayed power setting is adjusted to read apower equal to that of the internal power reference 41. This restoresthe laser to a calibrated state.

In some embodiments a diode lasing device calibration subsystem 71measures laser power exiting the delivery fiber 25, makes a comparisonwith a reference power 41 and uses a feedback loop to adjust the currentpassing through the Laser Diode(s). In this manner, the actual power ismade to converge with user-requested values. As a safeguard, thisfeature may ensure actual laser power delivered to the treatment sitecorresponds to a desired output setting made via the user interface.

The power meter may use detection sensors in measuring the energy of thecoherent light emissions such as emissions exiting the delivery fiber.Here, the power meter is an analog emission sensor whose output isconverted from an analog value to a digital value in an Analog toDigital (A/D) conversion.

Power meter 70 digital readings provide suitable accuracy and throughputwhich enables a microcontroller to make a timed or time-phased energymeasurement. This measurement of fiber emission is converted into anaverage power value and a comparison is made. For example, thecomparison may be with a reference average power value as mentionedabove. Thereafter, the microprocessor/microcontroller 50 issues adigital command which becomes an analog control signal presented to thelaser diode module 20 to adjust the current flowing through the laserdiodes 21. The output of the laser device 10 is adjusted as the currentflow through the diodes is adjusted.

Error messages and/or a halt to laser device 10 operation occur when themicrocontroller senses an error or unsafe condition or an error orunsafe condition that cannot be corrected. For example, themicrocontroller may issue an error message and temporarily halt laseroperation when a correction command exceeds safety envelopes dictated byoptical and electrical capacities of the laser device. Themicroprocessor may issue audible alerts transmitted via the transducerto notify the operator that laser operation has been temporarily haltedor to draw attention to critical time periods which have elapsed warningthat there is a potential for overpolymerization during the curingcycle, e.g., 3 and 5 second time markers, or to advise that laser lightdosimetry is nearing the maximum recommended therapeutic levels oradvise of the potential for overenergizing the target substance ortissue.

The output power is measured and displayed with precision by a functionthat measures, sums and displays the accumulated energy output, or lightdose delivered, in Joules, by the system during a specified time period.The user interface records the beginning time period from which theJoules of light emission energy are recorded. The energy is summed(accumulated) and displayed as the total Joules emitted from thebeginning time until present.

User Interface Housing

A diode lasing device or user interface housing 22 may include afront-mounted user interface 24. In a first embodiment, interface 24 mayuse tactile keypad buttons 26 providing for entry of fixed commands intoa system microprocessor 50. These commands are interpreted as input andcommand parameters by firmware resident in the microprocessor module.Results and responses are displayed on a screen 28 and may be indicatedby lamps 29. For example, light-emitting diode(s) (LEDs) may be withinkeypad buttons 26. While this embodiment 10 can be implemented withoutdifficulty, it may suffer from providing too little information to auser. However, it is expected that an experienced laser technician willbe able to operate this first embodiment without difficulty.

In another embodiment, interface 24 screen 28 may be a touch-sensitivedisplay allowing entry of commands without requiring mechanicalswitches.

In another embodiment, interface 24 may comprise a single keypad (notshown) with a screen 28 or screen capable of color display such asorganic light-emitting diode(s) (“OLEDs”) with capacitive 15touch-screen overlays or other moderate-to-high-resolutiontouch-sensitive displays such as those used for cellular telephones andother devices requiring touch screen command and display capabilities.

The display 28 may be within keypad buttons 26 or centered within keypadbuttons 26 as shown in FIG. 1. And, keypad buttons 26 may be used toenter fixed commands into microprocessor 50 with results displayed indetail on screen 28.

In this embodiment, more information may be presented on screen 28 withcolor functioning to communicate particular aspects of the informationsuch as state or degree. Embodiments above may use fixed commands ornot. These I/O (“input/output”) devices may include or be a part ofsubsystems intended to make the laser device immune or resistant toelectrical problems including interference, power surges, and strayradio frequency signals.

Laser device 10 activation may be accomplished by various meansincluding any devices that interpret human motion. For example, handmotion, foot motion, eye motion, knee motion, and the like. In someembodiments, the system is activated using foot or hand motion, forexample, a foot- or hand-manipulated switch 90.

In an embodiment, an electromechanical actuator, preferably a footswitch 90 is used. The switch may have normally open, single-throwmulti-pole contacts and may be located in a housing or mechanicalenclosure suitable for operation by the human foot. This foot switch maybe used to provide hands-free initiation of lasing and can be either acorded switch or a wireless switch known in the art. A corded footswitch may be used when interfering radio wave emissions areanticipated.

Power Supply

The system includes a power supply 30. Power supply inputs may be100-240 VAC and power supply outputs may be 12 VDC or 5 VDC at 3 A or 4A maximum. Power supply 30 may be a commercial supply with 100-240 voltsalternating current input and may be able to supply output current at 4A to circuit board 80 and cooling fan 60. The dental lasing device powersupply 30 may provide both 5 and 12 VDC to circuit boards 80 orcomponents requiring these voltages.

The lasing device is compact and portable. Laser diode module 20 may bemounted within a housing 22 such as an injection-molded plastic housing.Housing 22 may have a front-mounted user interface 24 adapted for useroperation.

In an embodiment, the housing is plastic and includes Acrylonitrilebutadiene styrene (ABS). The laser device 10 may have dimensions ofapproximately 10.5 inches long, 7.25 inches wide, and 6 inches high. Anyof these dimensions may vary by ±25%. The weight of the laser device isapproximately 2.5 pounds and the weight may vary by ±25%. See forexample FIGS. 2A-2D.

As described, embodiments of the present invention may include aplurality of individual parts. Similarly, methods may include aplurality of individual steps. These descriptions are intended toillustrate and may be augmented by additional parts or steps asindicated for carrying out the functions contemplated herein. Partsand/or steps may be changed, they may also be omitted and the order ofthe parts or steps may be re-arranged while maintaining the sense andunderstanding of the device and methods as claimed.

We turn now to particular embodiments of the lasers disclosed herein.Shown in the table below are blue lasers and infrared surgical lasersused in various applications. Red lasers are also included and used, forexample, as an aiming beam to make a combined beam visible.

LASER TYPE LASER CHARACTERISTICS Applications Blue Laser Wavelength 400to 510 nm Photopolymerization with a preferred range of Antibacterial440 to 460 nm and a typical Virucidal wavelength of 450 nm Incision andPower 0.1 to 5.0 Watts with excision a preferred range of 0.1 toHemostasis and 2.0 watts coagulation Emission mode continuous Diagnosticwave or pulsed Activate tooth Pulse frequency 0.1 Hz to whitening agent30 kHz with a preferred range of 10 to 50 Hz Pulse width 1 μs to 5seconds with a preferred range of 20 to 100 msec, with a 50% duty cycleInfrared Wavelength 800 to 1200 nm Preheating Surgical Laser with apreferred range of composite 1054 to 1074 nm and a Photobiomodulationtypical wavelength of 1064 nm Antibacterial Power 0.1 to 25 Watts withIncision and a preferred range of 0.1 to excision 3.0 Watts Hemostasisand Emission mode CW or coagulation pulsed Heat tooth Pulse Frequency0.1 Hz to whitening agent 30 kHz with a preferred range of 10 to 50 HzPulse width 1 μs to 60 seconds with a preferred range of 20 to 100 msec,with a 50% duty cycle Red Visible Wavelength 600 to 750 nm Aiming beamLaser with a typical value of 635 nm Photobiomodulation Power 1 mw to1.0 W with a typical value of 10 mW Emission mode CW or pulsed with atypical value of CW

The above blue and infrared lasers may provide CW outputs and pulsedoutputs. In various embodiments laser modes include one or more of (a)pulsed individual wavelengths, (b) pulsed consecutive wavelengths, c)sequential wavelengths, and (d) pulsed simultaneous wavelengths.

Duty cycles of the above are in the range of 0.3% to 99% for pulsedvariants. Where the duty cycle is 100% the mode is continuous. Opticalfiber core diameters for the above lasers range from 100 to 1,000 μm orin the range of from 300 to 400 μm.

Notably, where the treatment beam is not visible, an aiming beam isrequired. Aiming beams may be in a 600 to 750 nm wavelength range, beprovided a power of 1 to 1,000 mW, and be either of a CW or pulsedemission. In its higher power range this emission band can be used forPhotobiomodulation.

In various embodiments, photobiomodulation is a form of light therapythat utilizes non-ionizing visible and infrared light in a nonthermalprocess that results in beneficial therapeutic outcomes including butnot limited to the alleviation of pain or inflammation,immunomodulation, and promotion of wound healing and tissueregeneration. Photobiomodulation is also known as biostimulation, ananti-inflammatory treatment using selected wavelengths of light.Biostimulation releases adenosine triphosphate (ATP) from themitochondria of living cells to improve protein synthesis andupregulates several growth factors.

We turn now to examples of particular procedures that use embodiments ofthe laser device disclosed herein.

Dental Composite Heating and Photopolymerization: In this procedure,dental composite may be used, for example, to fill a tooth while thecomposite is pliable and thereafter be cured into a hardened state. Thisis a new and novel method involving the laser diode device 10 forheating composite in vivo and then polymerizing the composite.

-   -   1. The desired composite material is placed into the cavity        preparation of a tooth.    -   2. The appropriate laser safety eyewear is worn by the patient,        clinician, and other operatory personnel.    -   3. An optical fiber is placed into a handpiece.    -   4. The composite material is approached by the operator with the        handpiece and optical fiber to a designated distance from the        composite material, e.g., 2 to 20 mm.    -   5. The near-infrared diode laser is activated at clinically        relevant settings, e.g., 0.4 to 2.0 Watts, continuous emission,        and used to heat the composite for the desired length of time,        e.g. 5 to 30 seconds.    -   6. The blue laser beam is then activated automatically or        independently for photopolymerization (curing) of the composite        for designated time periods, e.g. 1 to 10 seconds, and settings,        e.g., 0.2 to 0.4 Watts, pulsed emission, 10-30 Hz, as selected        by the operator.    -   7. The near-infrared laser beam can be activated consecutively        or simultaneously with the blue laser beam at the operator's        discretion.    -   8. The blue laser beam can be activated according to specific        clinical need, e.g., photoactivation of bonding materials,        composite cements, composite restorations, endodontic composite        cores, prosthetic reline/repair material, sealants, splint        material, tack-curing of veneers and crowns.    -   9. A small “spot” size of designated diameter, e.g. 1 to 6 mm,        can be operator-controlled by varying the distance from the        fiber tip to the target area, e.g., 2 to 20 mm.    -   10. Bulk cure can be initiated by increasing the distance from        the composite, thus increasing spot size, with appropriate        operator-controlled adjustments made to output power to achieve        the desired power density for curing.    -   11. Composite may alternatively be cured through the structure        of the tooth enamel from the outside into the tooth cavity        preparation.    -   12. Composite may also be cured through nonmetallic matrix bands        (e.g., polyester, celluloid, and acetate) from the outside into        the tooth cavity preparation.    -   13. A ceramic restoration may be cured from the opposite side of        the veneer, for example, through tooth structure, to “shrink”        the composite toward the tooth.    -   14. Veneers and crowns may be tack-cured in one or two areas,        thereby anchoring the restoration in place and facilitating        removal of the uncured composite interproximally prior to final        photopolymerization.

Gingival Incisions and Excisions: It is noted that traditional surgicalexcision is difficult, is a source of post-surgical pain, and invitesbacterial colonization. Use of the laser procedures below mitigatesthese problems.

-   -   1. Anesthesia (topical or injection) is administered as needed.    -   2. The appropriate laser safety eyewear is worn by the patient,        clinician, and other operatory personnel.    -   3. An optical fiber is placed into a handpiece.    -   4. The blue laser is activated at clinically relevant settings,        e.g., 0.4 to 1.0 Watt, and the distal end of the fiber is placed        in light contact with the soft tissue to be incised or excised.    -   5. Alternatively, the fiber may be held slightly out-of-contact        with the target tissue, e.g., 1 to 3 mm away.    -   6. The fiber is moved with a rapid, smooth, stroking motion to        vaporize layers of tissue at a time.    -   7. As needed, cutting efficiency may be improved by keeping the        tissue taut.    -   8. For fibroma removal, the tissue to be removed is grasped with        forceps and pulled in a perpendicular manner while lasing.    -   9. The near-infrared laser may be used singularly or        simultaneously with the blue laser for soft tissue incisions and        excisions.    -   10. When used singularly, the near-infrared laser beam is        activated at clinically relevant settings e.g., 0.4 to 1.6        Watts, and the distal end of the fiber is placed in light        contact with the soft tissue to be incised or excised.    -   11. As needed to optimize tissue interaction with the        near-infrared wavelength, the distal end of the fiber tip may        first be initiated by lightly tapping the fiber end on a sheet        of articulating paper prior to placing the fiber in light        contact with the tissue.    -   12. When the two laser wavelengths are used simultaneously, the        parameters are adjusted to clinically relevant settings, e.g.,        0.4 to 1.6 Watts.

Tissue Retraction for Impression: Retractions require management of softtissue. Traditional soft tissue management includes hemorrhage controlwhile exposing prep margins and this requires additional time. Laserprocedures reduce problematic bleeding and soft tissue management time.

-   -   1. Anesthesia (topical or injection) is administered as needed.    -   2. The appropriate laser safety eyewear is worn by the patient,        clinician, and other operatory personnel.    -   3. An optical fiber is placed into a handpiece.    -   4. The blue laser is activated at clinically relevant settings,        e.g., 0.4 to 1.0 Watt, and the distal end of the fiber is placed        in light contact with the inner epithelial lining of the free        gingival margin, with the tip angled toward the soft tissue.    -   5. The fiber is moved with a constant, steady, circular motion        on the buccal, labial, and lingual surfaces to achieve a        full-360-degree trough.    -   6. The near-infrared laser may be used singularly or        simultaneously with the blue laser for soft tissue retraction.    -   7. When used singularly, the near-infrared laser beam is        activated at clinically relevant settings, e.g., 0.4 to 1.0        Watt, with the distal end of the fiber placed and angled as        specified above.    -   8. As needed to optimize tissue interaction with the        near-infrared wavelength, the distal end of the fiber tip may        first be initiated by lightly tapping the fiber end on a sheet        of articulating paper prior to placing the fiber in light        contact with the tissue.    -   9. When the two laser wavelengths are used simultaneously, the        parameters are adjusted to clinically relevant settings e.g.,        0.4 to 1.0 Watt.

Hemostatic Assistance: Dental surgical procedures frequently requirehemostatic agents. Tissue biopsies, placement of endosseous implants,and periodontal surgery are just some examples where hemostatic agentsmay be beneficial. Frequently there is a need to limit the use of thesehemostatic agents. Laser surgery provides a solution because the toolsand methods of laser surgery inherently reduce bleeding.

-   -   1. Anesthesia (topical or injection) is administered as needed.    -   2. The appropriate laser safety eyewear is worn by the patient,        clinician, and other operatory personnel.    -   3. An optical fiber with noninitiated tip is placed into a        handpiece.    -   4. The blue laser is activated at clinically relevant settings,        e.g., 0.5 to 1.0 Watt, continuous emission, and the distal end        of the fiber is held slightly out-of-contact with the targeted        soft tissue, e.g., 1 to 4 mm away.    -   5. The fiber is moved with a constant, sweeping motion over the        bleeding area.    -   6. The near-infrared laser may be used singularly or        simultaneously with the blue laser for hemostatic assistance.    -   7. When used singularly, the near-infrared laser beam is        activated at clinically relevant settings, e.g., 1.0 to 2.0        Watts, pulsed or continuous emission, with the distal end of the        fiber placed in light contact with the targeted soft tissue and        moved as specified above.    -   8. As needed to optimize tissue interaction with the        near-infrared wavelength, the distal end of the fiber tip may        first be initiated by lightly tapping the fiber end on a sheet        of articulating paper prior to placing the fiber in light        contact with the tissue.    -   9. When the two laser wavelengths are used simultaneously, the        parameters are adjusted to clinically relevant settings, e.g.,        0.5 to 1.0 Watt.

Adjunctive Use in Caries Detection: Visual diagnosis is the standard ofcaries diagnosis. Laser fluorescence not only provides for visualdetection but laser fluorescence can also be used for monitoring thedisease.

-   -   1. The appropriate laser safety eyewear is worn by the patient,        clinician, and other operatory personnel.    -   2. An optical fiber with noninitiated tip is placed into a        handpiece.    -   3. The blue laser is activated at clinically relevant settings,        e.g., 0.1 to 0.3 Watt, continuous emission.    -   4. The distal end of the fiber is placed in light contact with a        tooth surface and the illumination is observed on the opposite        surface. The fiber is redirected over the whole surface to        enable examination of the entire clinical crown.    -   5. Under blue laser illumination, areas of decalcification,        superficial stain, and decay appear darker than healthy enamel.        Carious dentin exhibits a characteristic luminescence.    -   6. The presence of decay is confirmed through conventional        means.    -   7. Blue laser illumination may also be used to determine whether        all decay has been removed during cavity preparation.

For the above procedures blue lasers may be used with wavelength of 400to 510 nm, power of 0.1 to 5.0 Watts, emission mode continuous wave orpulsed, and pulse frequency 0.1 Hz to 30 kHz with pulse width 1 μs to 5sec. For the above procedures, infrared surgical lasers may be used withwavelength of 800 to 1200 nm, power of 0.1 to 25 Watts, emission modecontinuous wave or pulsed, and pulse frequency of 0.1 to 30 kHz withpulse width of 1 μs to 60 sec. In various embodiments, aiming beams maybe used where the treatment beam is not visible, for example, a 600 to750 nm wavelength beam may be used with a power of 1 to 1000 mW and thebeam may be continuous wave or pulsed. In various embodiments deliveryoptical fiber core diameter range may be in the range of 100 to 1000 μm.In various embodiments, the duty cycle may be in the range of 0.3% to99% with 100% continuous wave operation.

We turn now to additional laser setup and laser operation proceduresthat use embodiments of the laser device disclosed herein. Examples ofuse of the laser device for dental procedures includingphotopolymerization of dental composites follow.

SETUP LASER OPERATION I. Photopolymerization using simultaneous methodof operation Place composite into a tooth. Press a foot switch or otherPosition laser optical fiber activator to simultaneously perpendicularto the resin-based activate near-infrared and blue composite (RBC)within 2 to 6 mm wavelengths and simultaneously of the RBC on/withintooth heat and photopolymerize the And/or additionally or RBC.alternatively position laser The light is delivered 3-5, 1-6, 4-8,optical fiber perpendicular to 8-20 second duration cure OPPOSITE sideand on/or near cycles, with user-selectable tooth 25 structure in orderto timing intervals. Audible polymerize THROUGH the tooth alarms areinitiated by the and polymerize the RBC from its microprocessor andtransmitted tooth/RBC contact interface through the transducer to drawAnd/or additionally or attention to critical time periods alternativelyposition the laser which have elapsed during the optical fiber to theOPPOSITE curing cycle, e.g., 3 and 5 second side of the restoration ortooth to warning periods, or to advise of cure through cement-based thepotential for overenergizing material. the target substance or tissue.II. For any dental composite: The operator will use a 300 to Press afoot switch or other 700 μm fiber delivery system. activator to activatethe laser. The operator will select from among 300, 360, 400 and 600 μmfiber delivery systems for the recommended embodiment. The proper curingcycle time range is 3 to 5 seconds. Placing the distal end of thedelivery fiber out of contact with the composite or in contact or nearcontact with soft tissue will permit the operator to cut soft tissue andcure composite simultaneously. III. Photopolymerization using sequentialmethod of operation Place composite into a tooth. Press a foot switch orother Position laser optical fiber activator to sequentially activateperpendicular to the resin-based near-infrared and blue composite (RBC)within 2 to 6 mm wavelengths and sequentially of the RBC on/within toothheat and photopolymerize the And/or additionally or RBC. alternativelyposition laser The light is delivered 3-5, 1-6, 4-8, optical fiberperpendicular to 5-10 second duration cure OPPOSITE side and on/or nearcycles, with user-selectable tooth 25 structure in order to timingintervals. polymerize THROUGH the tooth and polymerize the RBC from itstooth/RBC contact interface And/or additionally or alternativelyposition the laser optical fiber to the OPPOSITE side of the restorationor tooth to cure through cement-based material. IV. Automatically andsequentially after near-infrared selectable duration is complete, theblue wavelength is delivered, with user-selectable timing intervals.Blue light is delivered for 3-5, 5-10 Press a foot switch or otherseconds, user-selectable. activator to activate the laser. For anydental composite The operator will use a 300 to 700 μm fiber deliverysystem. The operator will select from among 300, 360, 400 and 600 μmfiber delivery systems for the recommended embodiment. Placing thedistal end of the delivery fiber out of contact with the composite or incontact or near contact with soft tissue will permit the operator to cutsoft tissue and cure composite simultaneously. V. Photopolymerizationusing overlapping, simultaneous, and sequential methods of operationPlace composite into a tooth. Press a foot pedal or other Position laseroptical fiber activator to activate near- perpendicular to theresin-based infrared wavelengths to heat the composite (RBC) within 2 to6 mm RBC. of the RBC on/within tooth Automatically after the near-And/or additionally or infrared selectable duration is alternativelyposition laser complete, the blue wavelength is optical fiberperpendicular to activated simultaneously with OPPOSITE side and on/ornear the near-infrared and delivered, tooth 25 structure in order towith user-selectable timing polymerize THROUGH the tooth intervals, toheat and and polymerize the RBC from its photopolymerize the RBC.tooth/RBC contact interface Near-infrared and blue light is And/oradditionally or delivered for 1-3, 3-5, 5-10 alternatively position thelaser seconds, with user-selectable optical fiber to the OPPOSITE timingintervals. side of the restoration or tooth to Automatically andsequentially cure through cement-based after the near-infrared and bluematerial. wavelengths selectable duration is complete, the bluewavelength is activated sequentially. Blue light is delivered for 3-5,5-10 seconds, with user-selectable timing intervals.

While various embodiments of the present invention have been describedabove, it should be understood that they have been presented by way ofexample only, and not limitation. It will be apparent to those skilledin the art that various changes in the form and details can be madewithout departing from the spirit and scope of the invention. As such,the breadth and scope of the present invention should not be limited bythe above-described exemplary embodiments but should be defined only inaccordance with the following claims and equivalents thereof.

1. A diode lasing method for dental oral surgery comprising the stepsof: providing only three laser diodes, a first of the three laser diodesis a blue laser with a wavelength 400 to 510 nanometers, a second of thethree laser diodes is an infrared laser with a wavelength of 800-1200nanometers, and a third of the three laser diodes is a red laser with awavelength of 600-750 nanometers; installing the laser diodes in a laserdiode module; installing the laser diode module, a power meter, aninternal reference, and a digital controller in a laser console having adisplay and user input interface; controlling the laser diodes via thedigital controller, the first laser diode for operation at 10-20 Hz witha pulse width of 20-100 ms and a power of up to 5 watts, the secondlaser diode for operation 10-50 Hz with a pulse width of 20-100 ms and apower of up to 25 Watts, the third laser diode for operationcontinuously with a power of up to 1000 mW; cooling the laser diodemodule with a Peltier cell thermoelectric cooler controlled by atemperature sensor, the Peltier cell between the laser diode module anda heat sink for dissipating the heat lost from the laser module;combining up to three light beams from the three laser diodes in anoptical stage including a transformation lens, a dispersion element, andan external cavity mirror wherein the three light beams impinge on thetransformation lens where the light beams are focused to a single pointon the dispersion element such that a single beam leaves the dispersionelement, impinges on the external cavity mirror; transporting areflection of the single beam in a single optical fiber with a corediameter of about 360 μm and a numerical aperture of 0.22 to 0.34,proper optical interface(s) being checked with one or more SMAdetectors; the digital controller interoperating with the internalreference and power meter to automatically calibrate the internalreference such that a laser power setting selected at the user inputinterface matches a power meter indication obtained when light from adistal end of the single optical fiber impinges on the power meter; and,performing laser surgery when a user aims the single beam from thedistal end of the optical fiber at tissue using visible red lightincluded in the single beam; wherein a dose meter displays a sum ofenergy delivered in Joules, a dose meter sum of energy deliveredbeginning at zero and summing during all laser emission periods.
 2. Thediode lasing method of claim 1 further comprising the step of:displaying energy delivered at a handpiece during a selected time periodduring which energy is delivered intermittently in response operation ofa foot switch.
 3. The diode lasing method of claim 2 further comprisingthe step of: utilizing the power meter to determine if laser powerdelivered at the handpiece equals a displayed power setting.
 4. Thediode lasing method of claim 1, wherein: activation of the first laserdiode but not the second laser diode cures any of bonding materials,composite cements, composite restorations, endodontic composite cores,prosthetic reline and/or repair material, sealants, splint material,veneers, and crowns via tack curing.
 5. The diode lasing method of claim4 wherein: in vivo dental composite heating is achieved when the secondlaser diode is operated a 0.4 to 2.0 Watts for 5 to 30 seconds with awavelength of 800 to 1200 nanometers; and, photopolymerization ofcomposites is achieved under control of the digital controller wherebythe second laser diode is automatically deactivated and the first laserdiode is automatically operated at 0.2 to 0.4 Watts for 1 to 10 secondsusing a 10 to 30 Hz pulsed emission.
 6. The diode lasing method of claim5 wherein: one or more composites are cured through 1) a nonmetallicmatrix band from an outside of a tooth cavity preparation into the toothcavity preparation or 2) bands including polyester, celluloid andacetate from an outside of a tooth cavity preparation into a toothcavity preparation.
 7. The diode lasing method of claim 5 furthercomprising the step of: providing a ceramic restoration including acomposite between a tooth and a ceramic restoration veneer wherein acomposite is cured from one side of the ceramic restoration veneerthrough a tooth structure until the composite shrinks toward the tooth.8. The diode lasing method of claim 5 wherein: one or both of a veneerrestoration and a crown restoration during initial photopolymerizationare tack-cured in one or two areas, the restoration(s) anchored in placeand interproximally uncured composite removed prior to finalphotopolymerization.
 9. The diode lasing method of claim 5, wherein: acomposite is alternatively cured through a structure of tooth enamelfrom an outside of a tooth cavity preparation into the tooth cavitypreparation.
 10. The diode lasing method of claim 9, wherein: ahandpiece is placed out of contact with a composite or in contact ornear contact with a soft tissue; and, the handpiece is used to cut softtissue and cure composite simultaneously.
 11. The diode lasing methodclaim 1 further comprising the step of: the digital controller providingtimed warnings of a) over-polymerization of a composite and b)over-energizing a tissue.
 12. The diode lasing method of claim 1 furthercomprising the step of: during a tissue retraction and impressionprocedure, operating the first laser diode at 0.4 to 1 Watt, operatingthe second laser diode at 0.4 to 1 Watt, moving a handpiece or distalend of the fiber with a circular motion on buccal, labial, and lingualsurfaces, and optimizing tissue interaction by lightly tapping thehandpiece or distal end of the fiber on a sheet of articulating paperprior to placing the handpiece or distal end of the fiber in contactwith tissue.